Clubfoot (talipes equinovarus) is a general term used to describe a range of unusual positions of the foot. Most types of clubfoot are congenital. The most common treatment for congenital clubfoot utilizes non-surgical casting or splinting, or a combination of both, with the treatment regimen beginning shortly after the patient's birth. The purpose of each step in the treatment is to move the affected foot (or feet, in the case of bilateral treatment) into the most normal position possible, and hold that position until the next treatment. These treatments are generally repeated every 1 to 2 weeks for a period of 2 to 4 months, moving the affected foot a little closer to a desired position each time. After treatment is complete, the patient usually wears a brace for an additional period of time in order to keep the clubfoot from beginning to form again. The type of brace chosen may depend upon the position of the patient's foot prior to casting or splinting, and other factors.
A rotation bar is one commonly used element employed in a clubfoot treatment regimen to either internally or externally rotate the patient's foot and leg. A rotation bar is a transverse bar extending between two special shoes, boots, or other footwear worn by the patient. Footplates are screwed, riveted, or otherwise attached to the soles of each of the shoes, and the bar is connected to the footplates at each end. An adjustable screw is used to hold the bar to each of the footplates. These screws may be loosened manually to adjust the angle of the shoe with respect to the bar. The degree of rotation internally or externally for each foot is thus set by rotating the corresponding footplate with respect to the bar, and then locking the footplate into a statically held position by tightening the screw connecting the bar and footplate. It should be noted that the bar may be a solid bar with various available lengths depending upon the size of the patient, or it may be a lap-over bar that is slotted to allow for adjustment of the separation between the patient's feet.
From the above description of the typical rotation bar it will be understood that, because the patient's shoes are fastened to the footplates by screws, rivets, or the like, the shoes are not intended to be removed from the bar during normal use of the device. Instead, the shoes are generally left attached to the rotation bar while being fitted onto and removed from the patient's feet.
Another common type of brace used in clubfoot treatment is a “90-degree brace.” Like the rotation bar, the 90-degree brace includes a footplate that is screwed or riveted to a shoe, boot, or other footwear, which is then fitted to the patient's foot. The purpose of the 90-degree brace, however, is to hold the patient's foot in a certain position with respect to the corresponding leg rather than the opposing foot. The brace fits under the foot at the footplate, has a 90-degree bend to travel up the back of the calf, and another 90-degree bend to follow under the knee and up the back of the thigh. The brace typically includes a calf and thigh band for attachment. The purpose of a 90-degree brace is to keep the knee and foot bent precisely at 90 degrees, and may be used unilaterally or bilaterally. By having the knee held at a 90-degree bend, the brace prevents the knee from going into extension, and therefore holds the foot and the shoe more effectively in the desired position with respect to the leg orientation. As with the rotation bar, the 90-degree brace generally attaches to the footplate with a screw that may be adjusted to control the angle of rotation between the footplate and brace.
Since the patient using orthotic devices such as the rotation bar and 90-degree brace described above is typically an infant, the brace must be routinely fitted and removed by a parent, guardian, or other adult. This process is complicated by the fact that infants will often resist any efforts to place shoes upon their feet. Because the brace is attached to the shoes at the footplates in such a manner that it may not be easily removed, the shoe is generally fitted with the brace still attached, rendering the process of fitting the shoe or shoes to the infant quite difficult. The person performing the fitting must position the shoe properly with respect to the patient's foot, while simultaneously ensuring that the attached brace does not swing about and injure the infant or the person performing the placement. In the case of a rotation bar, the person performing the fitting must then fit the other foot in the remaining shoe while both safely restraining the infant and positioning the foot and shoe for fitting. In the case of a 90-degree brace, the person performing the fitting must adjust the calf and thigh bands for a comfortable but secure fitting while preventing injury to the infant due to movement of the brace caused by the infant's foot movements. It would be desirable to fit the associated shoe or other footwear to the patient without the brace attached in order to simplify this procedure and reduce the chance of injury to the patient. What is desired then is a method of securely attaching the footwear to the orthosis that would allow the footwear to be easily removed and reattached for fitting of the footwear and orthosis to the patient.